Vertical Right Axillary Mini-Thoracotomy for Correction of Ventricular Septal Defects and Complete Atrioventricular Septal Defects.

Heinisch, Paul Philipp; Wildbolz, Marc; Beck, Maria Julia; Bartkevics, Maris; Gahl, Brigitta; Eberle, Balthasar; Erdös, Gabor; Jenni, Hans-Joerg; Schönhoff, Florian; Pfammatter, Jean-Pierre; Carrel, Thierry; Kadner, Alexander (2018). Vertical Right Axillary Mini-Thoracotomy for Correction of Ventricular Septal Defects and Complete Atrioventricular Septal Defects. The Annals of Thoracic Surgery, 106(4), pp. 1220-1227. Elsevier 10.1016/j.athoracsur.2018.05.003

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BACKGROUND

Vertical-right-axillary-mini-thoracotomy (VRAMT) is the standard approach for correction of atrial septal defect (ASD) and partial atrioventricular septal defects (PAVSD) at our institution. This observational single-centre study compares our initial results with the VRAMT approach for the repair of ventricular septal defects (VSD) and complete atrioventricular septal defects (CAVSD) in infants and children to an approach using standard median sternotomy (MS).

METHODS

Perioperative course of patients undergoing VSD and CAVSD correction through either a VRAMT or a MS were analysed retrospectively. The surgical technique for the VRAMT involved a 4-5 cm vertical incision in the right axillary fold.

RESULTS

Of 84 patients, 25 patients (VSD, n=15; CAVSD, n=10) underwent correction through a VRAMT approach, whereas 59 patients (VSD, n=35; CAVSD, n=24) had repair through MS. VSD and CAVSD-groups were comparable with respect to age and weight. No significant differences were observed for aortic cross-clamp duration, intensive care unit stay, hospital stay and echocardiographic follow-up. There was no need for any conversion from VRAMT to MS in any case. No wound infection nor thoracic deformities were observed in both groups.

CONCLUSIONS

VRAMT can be considered as a safe and effective approach for the repair of VSD and CAVSD in selected patient groups, and the outcome data appears comparable to those of median sternotomy.

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